Cervical Cancer

Cervical cancer is an overgrowth of abnormal cells on your cervix — the small canal that connects your uterus and vagina. Certain strains of HPV (human papillomavirus) cause almost all cases of cervical cancer.

It often doesn’t have symptoms until it begins to spread (metastasize). That’s why regular screenings (Pap smears) are so important. They can catch cervical cancer in the early stages when it’s highly treatable.

Treatment depends on the cancer stage. It typically begins with surgery. But you may need other forms of cancer treatment, like radiation and chemotherapy.

You can lower your risk of cervical cancer by getting the HPV vaccine and regular screenings.

Types

There are two main types of cervical cancer:

• Squamous cell carcinomas: Cancer develops in cells that cover your cervix’s outer surface. It’s the most common type. About 8 to 9 in 10 cases of cervical cancer are squamous cell carcinomas.
• Adenocarcinomas: Cancer develops in the gland cells that produce mucus in the inner surface of your cervix. Up to 1 in 5 cases are adenocarcinomas.

It’s also possible to have a mix of both types.

Symptoms of cervical cancer

Early stages of cervical cancer usually don’t cause symptoms. The first signs may take time to develop.

Signs and symptoms of stage I cervical cancer can include:

• Watery or bloody vaginal discharge that may be heavy and can have a foul odor
• Bleeding after sex, between menstrual periods or after menopause
• Pain during sex

If cancer has spread to nearby tissues or organs, symptoms may include:

• Difficulty or pain with peeing, sometimes with blood in your pee
• Diarrhea, pain or bleeding from your rectum when pooping
• Loss of appetite and weight
• Fatigue and a general feeling of illness
• Dull backache or swelling in your legs
• Pelvic and abdominal pain

Cervical cancer causes

Long-term HPV infection causes at least 90% of all cervical cancers. HPV is a sexually transmitted infection (STI). It often doesn’t cause symptoms. There are more than 200 strains of it. About a dozen of them can lead to cancer.

You may get HPV at some point in your life and not realize it because your body fights off the infection. But if your body doesn’t fight it off, it can cause the cells of your cervix to change, eventually becoming cancer.

Precancerous cell changes can progress slowly. It takes between three and seven years for abnormal cell changes to become cancer. But once they turn into cancer, it can progress quickly.

Pap smear tests can detect cell changes before they have a chance to turn into cancer. If you’re keeping up with regular Pap tests, cervical cancer isn’t likely to go unnoticed.

Risk factors

Most risk factors for cervical cancer are related to your likelihood of getting an HPV infection and your body’s ability to fight it off. Risk factors include:

• Sexual history and multiple pregnancies: Having sex before the age of 18 and having many sexual partners may put you at higher risk of HPV infection. Prior history of sexually transmitted infections and having multiple pregnancies are factors as well.
• Having a weakened immune system: Your body may be unable to fight the HPV infection.
• Smoking: Carcinogens in tobacco damage cervical cell DNA. Smoking also weakens your immune system.
• HIV infection: People with HIV have a higher-than-average risk of developing cervical cancer.

Risk factors unrelated to HPV include:

• DES (diethylstilbestrol): DES is a medication that was given to people between 1938 and 1971 to prevent miscarriage. If your mother took DES, you may be more likely to get clear cell adenocarcinoma, a very rare type of cervical cancer.
• Family history: Cervical cancer may have a genetic component.

How doctors diagnose cervical cancer

Regular cervical cancer screenings with a Pap test can detect most cases of cervical cancer. If it comes back as abnormal, the next step is typically an HPV test. It checks for the HPV strains that are most likely to cause cancer.

If you have high-risk HPV strains, your healthcare provider will want to do a colposcopy. This magnifies the cells of your cervix so your provider can take a closer look at them. They’ll likely remove some tissue and send it to a lab for testing.

They can use any of the following methods to get a sample of tissue from your cervix:

• Punch biopsy, which removes a small circular piece of tissue
• Endocervical curettage, which involves scraping the lining of your cervix with a spoon-shaped tool
• Loop electrosurgical excision procedure (LEEP), which uses an electrical wire loop
• Cone biopsy, which removes a slightly larger, cone-shaped piece of tissue

If the results from these tests confirm cervical cancer, you’ll need other tests (like imaging tests) to check whether the disease has spread. The results help your provider stage the cancer and determine the best treatment plan.

Cervical cancer staging

Cervical cancer has four stages. Within each stage, there can be several substages. The main stages include:

• Stage I: Cancer is just in your cervix.
• Stage II: Cancer has spread beyond your cervix and uterus. But it hasn’t yet spread to your pelvic wall (the tissues that line your pelvis) or your lower vagina.
• Stage III: Cancer has spread to the lower part of your vagina. It may also have spread to your pelvic wall, ureters (tubes that connect your kidneys and bladder) and nearby lymph nodes.
• Stage IV: Cancer has spread to your bladder, rectum or to distant organs, like your bones or lungs.

Your healthcare provider is the best person to discuss the stage and what it means.

How is it treated?

Treatment for cervical cancer depends on many factors, including its stage, your age and general health, and whether you want biological children.

Treatments for cervical cancer may include:

• Surgery: For very small cervical cancer, your provider can remove just the cancerous tissue. In other cases, they may need to remove your cervix (trachelectomy), uterus and cervix (hysterectomy) or other pelvic organs (pelvic exenteration).
• Radiation: Energy beams kill cancer cells. The two types include external beam radiation therapy (EBRT) and brachytherapy.
• Chemotherapy: Medications travel throughout your body and destroy cancer cells.
• Targeted therapy: Medications destroy specific cancer cells without damaging healthy cells.
• Immunotherapy: Medications trigger your immune system to recognize and destroy cancer cells.
• Clinical trials: You volunteer to take part in medical studies that involve potential new treatments for cervical cancer.
• Palliative care: This provides symptom relief, comfort and support.

Some people use alternative methods, like diet, herbs, acupuncture and others, to supplement their cancer treatment. Talk to your healthcare provider about alternative methods that claim to relieve cancer symptoms. Some may help, but others could be harmful.

Can cervical cancer be cured?

Yes. It’s a highly treatable cancer, especially in the early stages. Healthcare providers typically use the term “remission” to describe a cancer that has gone away. But it can still come back.

What can I expect if I have this condition?

Cervical cancer treatment can be hard and cause unpleasant side effects. Lean on your loved ones for help. Support groups can also be helpful when you need someone to understand what you’re going through.

Once treatment is over, your healthcare provider will want to monitor you closely to ensure the cancer doesn’t come back. Even if you reach remission, you may have cancer in the back of your mind, feeling worried that it can return. This is a normal response. Talking through your feelings with a counselor, close friend or a healthcare provider can help.

Survival rates

Survival rates for cervical cancer depend on the type. But they’re generally very good, especially for stage I. According to the U.S. National Cancer Institute, the five-year relative survival rates are about:

• 91% if cervical cancer hasn’t spread (almost half of all cases)
• 60% if cervical cancer has spread outside your cervix to nearby tissues
• 19% if cervical cancer has spread to your lymph nodes and distant organs

These statistics don’t necessarily predict what will happen to you. Your healthcare provider is the best person to talk to about your outlook, which is unique to you.

Can this be prevented?

Cervical cancer is one of the most preventable cancers. The HPV vaccine protects against 90% of HPV strains that cause cervical cancer. You must get the vaccine before developing an HPV infection to have this protection. Talk to your healthcare provider to see if the vaccine is right for you.

Getting regular gynecological exams and Pap tests is just as important as catching changes to your cervical cells early. Other things you can do include:

• Use condoms or other barrier methods when you have sex.
• Limit your number of sexual partners.
• Stop smoking and using tobacco products.